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use healthcare.gov even if no subsidy?
Old 04-15-2016, 09:44 AM   #1
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use healthcare.gov even if no subsidy?

I'll soon need to get private insurance. For the first time in my life, I won't be using insurance through my employer.

Our household income will be too high to receive a subsidy. My question is - are there any advantages to still using healthcare.gov, as opposed to buying directly from a broker or the insurer?

Thanks.
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Old 04-15-2016, 10:08 AM   #2
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I bought insurance directly through the Blue Cross website until this year where we signed up for the ACA. The health premiums for Blue Cross through the ACA for our state were identical to the Blue Cross website. Our income this year is too high to get a subsidy. However, we are retiring this year and next year the subsidy will be available to us.

We decided to move over to Healthcare.gov this year so we would already be enrolled when we retire.
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Old 04-15-2016, 10:14 AM   #3
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Originally Posted by mrfeh View Post
Our household income will be too high to receive a subsidy. My question is - are there any advantages to still using healthcare.gov, as opposed to buying directly from a broker or the insurer?

Thanks.
Not really. You will find that insurers offer policies directly to you or through brokers that are not available on the marketplace exchange. There is no price advantage to using the exchange vs a broker or direct.
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Old 04-15-2016, 11:37 AM   #4
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Our household income will be too high to receive a subsidy. My question is - are there any advantages to still using healthcare.gov, as opposed to buying directly from a broker or the insurer?
No, if you are certain there is no chance of an income decrease and qualifying for subsidy. There are more choices available off-exchange and all on-exchange plans are required to be offered off-exchange. Some off-exchange plans have larger provider networks. According to the chart below, only 0.6% of the population buys non-subsidized plans through the exchange while 1.9% of the population uses off-exchange plans.

http://www.acasignups.net/sites/defa..._pie_chart.jpg

Be aware that many insurers have eliminated commissions on individual plans during 2016. If you use a broker, be sure they are showing you the best plans for your situation and not just plans that still pay a commission.
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Old 04-15-2016, 12:12 PM   #5
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As someone else mentioned, BCBS prices were the same... I did not see any plans on their site that were not on the exchange...


BUT, there is one advantage buying yourself instead of thru the exchange... you do not have to deal with the exchange!!!


A few years ago I was on the exchange... then worked for a few months and had company insurance... did not inform the exchange as I thought not paying would be enough info to the insurance company that I was not using them anymore... NOPE!!

So when I signed up the next year I saw I had 7 months of bills outstanding with BCBS... called them to say I had other insurance etc... but was told 'you have to go through the exchange'...

This year when I bought dental through the exchange and then found out they lied and only paid half of preventive when they said 100% I wanted to cancel.... so called them and again 'you have to go through the exchange'... it was pretty easy to get this insurance cancelled, so maybe not a big deal...
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Old 04-15-2016, 12:18 PM   #6
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All else being equal, if I wasn't expecting a subsidy I wouldn't bother using the exchange. That said, I think littleb's reason for using the exchange is a good one -- make sure all the potential tripping points are resolved while you don't expect a subsidy, so you're in the clear when you do.
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Old 04-15-2016, 01:34 PM   #7
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I agree with the posters above. Going through the exchange just adds one more layer of complexity and possible issues for absolutely no benefit to you.

If you think there is even a slim chance that you'll qualify for subsidies, then of course, you should use the exchange.
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Old 04-15-2016, 03:46 PM   #8
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A few comments.. yes the only reason to go through the exchange is the subsidy.. I didn't think I'd use it but then last year in the end I found out I could have.. Grrr.. and because I didn't buy it via the exchange, I was just SOL.. though I did end up using that medical tax deduction I always wondered how people qualified for because I hit over 10% of my income for the year.

If you do buy through the exchange I did notice the same plan is often listed but are not exactly the same.. ie my BF doesn't get a subsidy but I do and even though the plan is called the same thing, the underlying rules are slightly different. It seems there is an A, B, C, D, and at least E plan. Most of this is to account for various clauses for reduced co-pays, deductibles, etc. However, if my BF should happen to get layed off this year, it would be very easy to call into the exchange, keep the same plan but move from E to C and thus same doctors, same pills covered, etc.

Last year we didn't go with the exchange because a broker found us a United had a plan not on the exchange that had a separate $750 drug deductible that...given my BF takes a pill that would max that out in 3 months time, that was an easy choice.. yes we would like free pill for 9 months out of the year.
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Old 04-15-2016, 04:28 PM   #9
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A few comments.. yes the only reason to go through the exchange is the subsidy.. I didn't think I'd use it but then last year in the end I found out I could have.. Grrr.. and because I didn't buy it via the exchange, I was just SOL.. though I did end up using that medical tax deduction I always wondered how people qualified for because I hit over 10% of my income for the year.

If you do buy through the exchange I did notice the same plan is often listed but are not exactly the same.. ie my BF doesn't get a subsidy but I do and even though the plan is called the same thing, the underlying rules are slightly different. It seems there is an A, B, C, D, and at least E plan. Most of this is to account for various clauses for reduced co-pays, deductibles, etc. However, if my BF should happen to get layed off this year, it would be very easy to call into the exchange, keep the same plan but move from E to C and thus same doctors, same pills covered, etc.

Last year we didn't go with the exchange because a broker found us a United had a plan not on the exchange that had a separate $750 drug deductible that...given my BF takes a pill that would max that out in 3 months time, that was an easy choice.. yes we would like free pill for 9 months out of the year.
You bring up some important issues when looking for health insurance either through an independent insurance company or the Healthcare.gov site.

When you get your health insurance through your employer you are given the option of 3-4 different plans and usually provided comparisons of the various plans. The differences in deductibles, monthly premiums, percentage of benefits paid after meeting the annual deductible and out of pocket maximums per year. It is easy to see the differences and decide on the best plan for you and your family.

When shopping for insurance outside employer plans you must take the time to understand and compare each plan offered. You might find a plan for 250.00 per month but the annual deductible is 6,000. Or there may be a plan with a low deductible that only pays 50% benefits once your deductible is met.

The plans offered with BCBS in my state have the above types of coverage but even go deeper with doctors and hospitals that are covered in network. They have an E plan, an S plan and a P plan. The E plan is for economy and may have the lowest premiums but also limited doctors and hospitals. The S plan is middle of the road and the P Plan is the cadillac plan that usually has the majority of the drs. and hospitals in the network. Of course the P Plan is the most expensive. Years ago most employers offered the P plan but as healthcare costs have escalated some dropped to the S plan.

I had Blue Cross for over 10 years with my employer so I understood the differences in the plans prior to buying an individual plan through BCBS or through the ACA.
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Old 04-15-2016, 05:54 PM   #10
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Originally Posted by mrfeh View Post
I'll soon need to get private insurance. For the first time in my life, I won't be using insurance through my employer.

Our household income will be too high to receive a subsidy. My question is - are there any advantages to still using healthcare.gov, as opposed to buying directly from a broker or the insurer?

Thanks.
What about COBRA? Often cheaper than attempting to obtain coverage on your own. And if you're in California, don't forget about CAL-COBRA, providing 18 months of additional coverage after the 18 months of Federal COBRA ends for a total of 36 months of coverage after leaving your employer. In my case, COBRA is less than using the ACA with better coverage even with subsidies (seeing as how I owe almost nothing in taxes each year, the subsidies would be useless anyway).
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Old 04-15-2016, 06:25 PM   #11
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Originally Posted by littleb View Post
You bring up some important issues when looking for health insurance either through an independent insurance company or the Healthcare.gov site.

When you get your health insurance through your employer you are given the option of 3-4 different plans and usually provided comparisons of the various plans. The differences in deductibles, monthly premiums, percentage of benefits paid after meeting the annual deductible and out of pocket maximums per year. It is easy to see the differences and decide on the best plan for you and your family.

When shopping for insurance outside employer plans you must take the time to understand and compare each plan offered. You might find a plan for 250.00 per month but the annual deductible is 6,000. Or there may be a plan with a low deductible that only pays 50% benefits once your deductible is met.

The plans offered with BCBS in my state have the above types of coverage but even go deeper with doctors and hospitals that are covered in network. They have an E plan, an S plan and a P plan. The E plan is for economy and may have the lowest premiums but also limited doctors and hospitals. The S plan is middle of the road and the P Plan is the cadillac plan that usually has the majority of the drs. and hospitals in the network. Of course the P Plan is the most expensive. Years ago most employers offered the P plan but as healthcare costs have escalated some dropped to the S plan.

I had Blue Cross for over 10 years with my employer so I understood the differences in the plans prior to buying an individual plan through BCBS or through the ACA.

All that info is on the site and you can compare the plans pretty easily... that is except for the doctors in a plan... they were trying to get that info this last sign up period, but it was not there... maybe next year...


Also, the cost of the 'better' plans are not worth it IMO.... the difference between a bronze plan and a silver is (IIRC) about $300 per month... I would have to have a major problem to make that up....
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Old 04-15-2016, 09:27 PM   #12
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DH went to BCBS and got info when we first had to buy insurance on our own. Income too high through minimal independent contract work +passive income to get subsidy. The premiums through the exchange were 10% lower than direct. So we went with the exchange.

It turns out BCBS undercut the premiums to try to capture market share. So the premiums jumped, and they dropped our plan, and we went with a different company. It turns out BCBS posted a significant loss last year in PA. So two months into the year they cut payments to doctors 5% across the board. The state medical society is crying foul.

We looked into Cobra--40% more expensive than ACA plan. No thanks.


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Old 04-15-2016, 10:51 PM   #13
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What about COBRA? Often cheaper than attempting to obtain coverage on your own. And if you're in California, don't forget about CAL-COBRA, providing 18 months of additional coverage after the 18 months of Federal COBRA ends for a total of 36 months of coverage after leaving your employer. In my case, COBRA is less than using the ACA with better coverage even with subsidies (seeing as how I owe almost nothing in taxes each year, the subsidies would be useless anyway).

We thought we'd get Cal-COBRA, but because the company was headquartered in another state, we couldn't get it. That was a surprise.


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Old 04-16-2016, 10:40 AM   #14
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Not really. You will find that insurers offer policies directly to you or through brokers that are not available on the marketplace exchange. There is no price advantage to using the exchange vs a broker or direct.
Absolutely, had no issues going through Humana last year before we went on ACA this year and I would highly recommend only using the exchange for a subsidized plan. There was no cost difference going direct to the insurer for the exact same plan I could've had on the exchange, so why add a government layer that is often broken?
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